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National Eating Disorders Awareness Week is Coming Up!

February is National Eating Disorders Awareness Month. Eating disorders effect 1 or 2 out of every 100 children and are becoming more common, but many children and adults are able to hide eating disorders from their families for months or even years because they wear loose fitting clothes and appear to eat a healthy diet. Several of the causes for this increase in eating disorders include constant pressure from sports, movies, television and magazines to be abnormally slender. Many sports such as wrestling and gymnastics dance and acting also make weight and body image a huge issue. If you don’t weigh what the coach or director wants, you don’t compete in the big meet or get the best part in the play. Magazines at the grocery checkout, where I get my up-to-date medical information, always have articles featuring the thinnest people.

The two most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia and bulimia are very similar, but people with anorexia are usually very thin and underweight and people with bulimia may be a normal weight or even overweight. People with anorexia or bulimia frequently have an intense fear of being fat or think that they are fat even if their weight is normal. People with eating disorders also can have serious physical health problems, such as heart conditions or kidney failure and in severe cases suffer from severe malnutrition and may even die. The best-known example of a tragic outcome from an eating disorder is that of Karen Carpenter, the great singer, who died of heart problems after struggling for years with anorexia nervosa.

People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape and try to maintain a very low body weight. Some restrict their food intake by dieting or exercising for hours. The small amount of food they do eat becomes an obsession. People with anorexia become very thin; weigh themselves at least once a day; count calories and portion the food they eat very carefully; only eat certain foods; withdraw from social activities; and may door poorly in school because they get lightheaded and are unable to concentrate because they are starving.

Compared to people with anorexia who eat almost nothing, people with bulimia usually eat a huge amount of food, such as pizza, cakes, cookies or ice cream that almost dissolve in your mouth without chewing. They only stop eating when they are too full to eat any more or run out of food. Then they try to get rid of the calories they ate by vomiting, exercise for hours or use laxatives to not gain weight. People with bulimia also have health problems because constant vomiting can damage your stomach and kidneys; cause tooth decay from the stomach acids you throw up; and the loss of minerals such as potassium which can lead to heart problems and death.

I treat children and adults who have eating disorders by helping them to establish new patterns of thinking about food and to deal with their disordered eating patterns. I help children to think about their body size, shape, eating, and food. I also use nutritional counseling, and individual and family therapy because parents and other family members are vital to help children see their normal body shape is fine and that being excessively thin can be dangerous.

As a mother, your own eating habits and how your deal with your own body image is a great influence on how your children think about food and how they look. Create a healthy lifestyle for your family by involving your kids shopping for and cooking healthy, nutritious meals. In addition to the nutritious meals, make exercise a fun, rewarding, and regular family activity.

BRIEF SENTENCE ON THE AUTHOR

Dr. Grubb is Board Certified in Adult and Child and Adolescent Psychiatry and is a member of the Behavioral Health Team at the National Naval Medical Center at Bethesda, MD specializing in pediatric and family issues with weight. Dr. Grubb is a staff psychiatrist at the Columbia Counseling Center and can be reached by contacting the Center.

Men and Women in the Military. Studies also show a higher-than-average risk for eating disorders in men and women in the military. A study of eating behavior on one Army base reported that 8% of the women had an eating disorder, compared to 1 – 3% in the civilian female population.

About the author: Charlie

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Dream a Little Dream

It is common practice in psychoanalysis for the patient to report the content of dreams as part of treatment. Sigmund Freud believed that dreams were a window into the unconscious mind. Therefor, by understanding and interpreting the content of dreams the patient would reveal thoughts and images that would possibly clarify current or past experiences, feelings and actions.

Dream analysis, once in vogue for both patients and doctors, has given way to what is termed cognitive-behavioral therapy, or CBT. A CBT approach to treatment might view dream content as random neural activity. However, if one considers the complexity of our dreams and the fact that there are repetitive themes and images,frankly, that hardly seems “random.” CBT examines cognition,our manner of thinking about issues. It also evaluates and treats behavioral concerns, like nail biting, smoking or other compulsive behaviors. Dream analysis is more within the realm of psychotherapeutic approaches that incorporate a deeper analysis of the complex developmental issues, or psychodynamics, which are the causal basis of personality and cognitive concerns.

The dream is divided into two components. The first level of analysis is the manifest content ( which is the actual experience of the dream). “I was driving my car down a mountain road and I had no brakes!” The second level is the latent content of the dream,( what the dream really means). In this case it might be a feeling of loss of control or an inability to control something. We dream in symbols. If we identify certain people in the dream that image could be a “stand-in” for someone else. Dreaming about snow could represent depression or a desire to “cover up” something or jus a pleasant memory of childhood.. So, how do we know the “correct” interpretation? The symbolic items in the dream can be better understood if interpreted within the context of that particular person. Freud suggested that we dream in symbols to “protect” our sleep. If we see through the symbolic process it can cause anxiety and would awaken us, possibly identified as a nightmare.

Dreams can be viewed as the dreamer’s attempt to “work through” or resolve some conflict that they are experiencing in reality. Another aspect of the dream is “wish fulfillment.” Within a dream one can see themselves mastering a task or problem. Apparently, we experience dreaming several times on most nights, even if we do not recall the experience. However, some medications can interfere with neurological function and inhibit dreaming. Interestingly, we seem to have a need to dream.In a classic study people were awakened as they began to dream.It was easy to identify the dream state since dreams are accompanied by rapid eye movements that can be identified and recorded. This procedure occurred for several days. Finally when the subjects were allowed to sleep, their number and frequency of dreams increased. Deprived of dreams, people began to dream more; possibly to make up for the deficit. Dream deprivation increases dreaming when subjects are permitted to have normal sleep.

Finally, dreaming is the only time that we can really “time travel.” One can be a young child in the dream and instantly become a teen or young adult. While the meanings in dreams may be elusive, they can provide meaningful thoughts and ideas that can help the patient to overcome the challenges and the demands of life that have brought them to treatment.

The Columbia Counseling Center offers an eclectic and integrated approach to treatment. The doctors on our staff are trained in the use of multiple techniques and strategies to relieve anxiety, improve mood and effectively modify coping strategies.

You can call 410 992 1949 for the first available appointment.

The Serotonin – Depression Connection

Recent articles( such as this piece from psychcentral.com have posited the notion that serotonin is not a significant component of the depressive process .Further, that drug companies, having developed serotonin enhancing medicines, began an advertising campaign to “convince” the public that serotonin was the “cure” for depression.The idea that drug companies would conspire to mislead the public is quite questionable ( although I do enjoy a good conspiracy theory). One of the problems is that we cannot measure serotonin in the brain directly. Further, if we manipulate serotonin with an SSRI (selective serotonin re-uptake inhibitor), this also disturbs the balance of norepinephrine and dopamine- two of the major neurotransmitters. Now, it is really more complicated than this. There are many sub-types of each of these substances so it is not a simple matter of manipulating one of these chemicals.There are also many sub-types of receptor sites in the brain. The more we learn about the chemistry and structure of the brain, the more complicated it becomes.

The data from numerous studies indicates that psychotropic medications may only work about 50% of the time. In addition, psychiatrists may have to try a number of different medications in order to gain a positive effect. Of course, patient compliance is always a problem. It is not a good idea to wash your Prozac down with scotch whiskey – but I have had a number of patients who have done just that!

Michael Greger points out that diet ( whole food plant based nutrition) and exercise may be just as effective as some anti-depressants. While there is merit to this assertion, trying to get a depressed patient to exercise and eat properly is quite challenging – to say the least! It is my impression that “comfort foods” carbohydrates, potatoes, bread, mac and cheese act as “comfort foods” because they do, in fact, raise serotonin levels along with a number of other “calming” chemicals (such as tryptophan) that do cross the blood-brain barrier. Unfortunately, a bag of potato chips only increases serotonin levels for a couple of hours.

It does appear that cortisol is a precipitating chemical in the depressive process and influences a decrease in certain neurotransmitters. Indeed, being in a stressful situation for two to six weeks can trigger a depressive episode. This is chemistry, not “psychological” weakness. The notion that neurotransmitters are the causal factors in the depressive process is strengthened by the apparent genetic relationships within families. If we examine the family of origin of a depressed patient we will find both genetic and psychogenic factors that contribute to the depressive process. Further, it is interesting to note that if a particular antidepressant medication is effective for a “blood relative” ( biological parent or sibling) there is a high probability that the medicine will be effective for the patient.

The “holy grail” of treatment for depression will not be easily discerned. Light therapy can be effective. Likewise, trans-cranial stimulation shows promise. Various approaches in psychotherapy can be quite effective. However, anti-depressant medicines will continue to be a major component of treatment.Columbia Counseling Center’s integrated treatment protocol carefully evaluates the multiple causal factors in depression and provides both pharmacological and psychotherapeutic approaches for maximum effective treatment of depression.
Call 410 992 9149 for the next available appointment.

The Most Powerful Treatment for Depression

The title of this 2008 study says it all: “Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone”. The study of over 650 patients with depression compared medication treatment alone to medication treatment plus psychotherapy. The results were clear: patients on medication and therapy recovered from chronic (meaning repeated episodes of) depression faster than patients on either treatment alone.

Many studies over the years have identified both cognitive-behavioral therapy and interpersonal psychotherapy as being just as effective as medication in reducing symptoms of moderate depression. Other studies have shown that the improvements gained in therapy alone can last longer than the improvements gained from medication alone.

In my opinion, it’s the minority of cases that improve on just medication. The job of antidepressant medicine is to reduce the most immediate and troubling symptoms that interfere with your ability to function at home, at work, and socially: low energy, loss of interests, poor concentration, crying spells, hopelessness, and suicidal thoughts. The job of therapy is to identify the life issues that have led to depression and make changes in how you deal with those issues so they stop depressing you.

Therefore, we have two powerful and effective tools to treat depression. Use them together and you are likely to get the fastest and most enduring relief from your symptoms. At Columbia Counseling Center, the psychiatrists and therapists are all under one roof and we work with each other to ensure that your treatment is coordinated and efficient.

Written by: Dennis Glick, M.D. Board Certified Psychiatrist at The Columbia Counseling Center

Generalized Anxiety Disorder (GAD) is a common and recurring condition. Typical symptoms include near-daily worry, anxiety, tension, feeling on edge, irritability, and sleep disturbance. Features of panic attacks and/or social anxiety may also be present. Your primary care doctor may have already ruled out medical causes such as thyroid, electrolyte, cardiac, or nutritional abnormalities.

Cognitive-behavioral therapy (CBT) is a very effective form of treatment, typically requiring 6 to 12 weekly sessions that may include the use of workbooks and homework. The SSRI and SNRI antidepressant medications (Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, and Pristiq) are highly effective and should be continued for a period of 6 to 12 months following symptom reduction. Benzodiazepines such as Xanax, Ativan, and Klonopin are best used on a temporary basis due to the risks of addiction, memory impairment, physical incoordination, and potentially endangering combinations with alcohol and pain killers. Other medicines such as Buspar, Vistaril, Gabapentin, and Seroquel are occasionally used but are not specifically approved for treatment of GAD.

Many patients will benefit from the combination of CBT and medication. The Columbia Counseling Center is uniquely able to provide coordinated treatment as our staff includes both psychiatrists and psychologists specifically trained to diagnose and treat GAD and other anxiety and mood disorders. Your clinicians work together to ensure you are receiving the most effective treatments for your condition.

Conflict Resolution vs Separation

By Dr. Susan Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.

 

 



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